Why Do Some Coccyx Injections Not Help for Tailbone Pain, Coccyx Pain

There are multiple reasons why some coccyx injections do not help to relieve coccyx pain (tailbone pain, coccydynia).

The physician doing the injection did not start by accurately diagnosing cause of the tailbone pain.

If the doctor has not tried to figure out exactly what is causing the pain, how would he/she understand the proper type of injection to do?

Also, how would the doctor know exactly where on the tailbone to do the injection?

For example, if there is one specific joint that is dislocating on the sitting-versus-standing x-rays, then it makes sense that the injection should target that specific joint.

Or, if the pain is being caused by a bone spur down at the lower tip of the coccyx, then it makes no sense for the physician to be focusing their injection up at the top of the coccyx.

This the MOST COMMON reason why injections do not help…. the doctor did not first make an accurate diagnosis.

I have seen this happen to countless patients who travel to see me to help figure out why the injections done by their local pain management doctors were not giving them relief.

The injection was done without imaging guidance (fluoroscopic guidance).

The bones and joints of the tailbone are small. That means that they are very small targets for injection.

Using fluoroscopic imaging during the injection helps the physician to more confidently know that the needle is placed at the correct location.

Injections done without imaging are sometimes referred to as “blind injections.”

Blind injections might be in the general area of pain. They may be nearby to the site of pain. But maybe not.

Regardless of whether someone gets great relief or no relief, it was a blind injection then neither the physician nor the patient is 100% sure about where the injection was done.

Lack of imaging guidance can also explain why sometimes the injections are helpful and sometimes they are not. Some of the injections may have placed the medication at the most helpful area. But other times the injections might have failed to place the medication at the best location.

The injection was not done at the coccyx.

This is crazy but true.

It is VERY common that a patient suffers from tailbone pain, but the treating physician is not very familiar with doing tailbone injections. So, the physician instead does a lumbar injection or a sacral injection, and “hopes” that this will somehow help the tailbone.

If possible, obtain a copy of your injection procedure note to specifically see whether you even received a coccyx injection. You may discover that the injection was a lumbar epidural, or a caudal epidural, or a sacroiliac injection. None of those are injections at the coccyx.

The pain is not coming from the coccyx.

If your pain is coming from someplace OTHER than your coccyx, then it is not surprising if an injection at the coccyx does not give relief.

For example, pain in the general coccyx area might be actually coming from the anus, rectum (large intestine), or a pilonidal cyst. Worse yet, the pain might be coming from a mass or cancer (malignancy). Cancers and other masses can start within the pelvis (such as prostate cancer, ovarian cancer, uterine cancer, cervical cancer, rectal/colon cancer, etc.).

The underlying coccyx problem has gotten worse, so that injections are no longer adequate treatment.

It is possible for underlying condition to worsen over time.

If the underlying condition is worsening, it made no longer respond as well to treatments that previously were very helpful.

Out of all these, the most common reason why coccyx injections fail to relieve coccyx pain is #1 above. The treating physician did not accurately diagnose the cause of the tailbone pain in the first place.